NHHIMA Scholarship ApplicationNHHIMA Scholarship Application Applicant InformationName * Name Name Name Credentials AHIMA Membership ID # Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Email * Phone * I am applying for: * HIT/HIA Degree Scholarship Masters Degree Scholarship Coding Program Scholarship Other Healthcare related program Scholarship (specify)Other Healthcare related program Scholarship (specify)Current Educational Institution Name of School * Name of Academic Advisor * Phone * Program Enrolled In * HIT Program HIA Program Other Program (please specify)Other Program (please specify) Date Studies Began * Expected Graduation Date * Resume and Essay Resume * Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Why have you chosen a career in health information management? * What do you see as current or upcoming challenges in the field of HIM? What changes do you see happening in the field in order to meet these challenges? * What are your long-term professional goals? * References and Proof of NH Residency or Employment in NHPlease submit two reference letters. References may be from educators, employers, or other health information professionals (no more than one letter may be from an instructor). Reference Letter #1: * Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Reference Letter #2: * Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Proof of NH Residency or Employment in NH * Drop a file here or click to upload Choose File Maximum upload size: 268.44MBTranscriptPlease provide a current transcript documenting completion of most recent semester (official transcripts are not required, but are encouraged). Transcript * Drop a file here or click to upload Choose File Maximum upload size: 268.44MBMy name will be posted to the NHHIMA website if I am awarded a scholarship. * Agree Disagree If you are human, leave this field blank. SubmitΔ
